Acting CMS Administrator Andy Slavitt on Wednesday urged all lawmakers to improve on the progress made by the Affordable Care Act, rather than plunge the healthcare industry into chaos if the ACA is repealed and inadequately replaced, or isn't replaced at all.
“There should be no pride of authorship,” Slavitt said. “If we can improve upon the things that were started in the ACA, we should do it. It doesn't matter if that comes from a Democrat. It doesn't matter if it comes from a Republican. I would encourage people on both sides of the aisle to say, 'Let's take a step forward, let's focus on the things that haven't been working.'”
Slavitt spoke Wednesday morning at Modern Healthcare's 2016 Leadership Symposium in Chicago during a one-on-one interview with editor Merrill Goozner.
Slavitt said the ACA has helped lower the uninsured rate to 9.1% and expand health insurance to people previously denied coverage for having pre-existing medical conditions. He also said the ACA has been instrumental in improving quality of care measures and bending Medicare's cost curve.
But now as the new administration under President-elect Donald Trump takes control of the White House, the future of the ACA is on increasingly shaky ground. Congressional Republicans have vowed to repeal and replace the ACA, but have given few details surrounding a replacement plan.
Insurers are unsure how to set premium rates for 2018, which are due in the spring. Hospitals are concerned the progress they made toward value-based care will be stripped. And consumers have made thousands of calls to the HealthCare.gov call center asking what will happen to their coverage.
“We're dealing with a third of the economy,” Slavitt said of the healthcare industry. “If you want to do a do-over, which is the other alternative to building on our progress, you're going to take a third of the economy and thrust it into some deep uncertainty.”
He warned that lawmakers could move the healthcare system backwards, and a replacement plan should be judged by a four-question test. Will the new plan provide coverage for as many people? More than 20 million people have gained coverage under the ACA.
Does it provide the level of protection under the ACA? Is it affordable? Slavitt pointed out that most people enrolled in exchange coverage can find a plan for $75 a month, although millions of people who buy coverage off the exchanges have to pay full freight without any subsidies. Finally, is the replacement plan fiscally responsible?
Slavitt also touched on the future of Medicaid under the incoming administration. Rep. Tom Price (R-Ga.), Trump's pick to lead the HHS, has supported turning Medicaid into a block-grant program with a per-beneficiary cap.
That “would be disastrous,” Slavitt said, warning that block grants would require funding cuts that could harm children, seniors and people with disabilities.
On the ongoing shift from a fee-for-service system that pays for every procedure to one based on paying for quality and outcomes, Slavitt said the U.S. is moving slowly to test programs, but it's making progress.
We're only on “the iPhone 2” version of accountable care organizations and medical homes, he said. “They are going to get a lot better…provided CMS does its job right.”
Prescription drugs—especially specialty drugs, which have grown heavily in cost—are an opportunity for value-based reimbursement arrangements. But the greatest tool in reining in drug prices is transparency, Slavitt said.
The CMS is slated to release information Wednesday on more than 5,000 drugs and their pricing history over the last five years, Slavitt said.
“It's important not to use it as a cudgel,” he said, but instead “to get away from the world of anecdotes” surrounding drug price hikes.
